Laserfiche WebLink
� <br /> //��// Pu�nc wm�e Permil� ���_— I <br /> A 'T � <br /> Ucl�l't: / 6iaBDeo�• ' <br /> Application Por <br /> pUBLl� WORKS PERMIT P,aTo�FeeFee 5����- <br /> lau AOD�Fee PaiJ S� � <br /> 0a�ancaDie f J ____ <br /> Print or Ty;!e Or.ly � <br /> 1 ' (�c� r� -�.11 5c` L^Jev z'( F�t14'���'a 3�S ' l�l-,�� <br /> �,L7�L C � 1 /! r`iV sr/ L ZP '� Phone <br /> Cwner Ma�6ng AAdres ���Y <br /> • S �P / 1 � � ���� Phone <br /> '�pplicant Mading Address City ziP <br /> .�-ao y,g.� Fi�c= F/�PC"v�� .�, <br /> Oescribe Proposed Work e) <br /> /��-T�—T /�i�2T �� 'i <br /> �-jLG �.�__!o T �S <br /> � i <br /> — .. //� � /�- ,�'L <br /> Project Address(il known) _.�� Q�--+ � � <br /> Ba <br /> � AttaCh lour(4)coPies ol plans for proposed work• Draw lo scaie and note Ihe follovring as appl�caCle: � I <br /> • Property L�aes • Centerline ol street <br /> • Outlme and dimens�nns of all?xisting a��d • Indicate North <br /> proposed structures on the lot • Show any proposed grading changes ; <br /> • Existing and proposed utilities <br /> O Show measu�emenl5 � '�, <br /> DO NOT Wf71TE BELOW THIS LItJE � <br /> PERMITCONDITIONS � . <br /> 1. All calls for inspection shall be made 24 hrs in advance� phone 259•881$. <br /> 2. All work shall be periormed in accordance with this permit ard current Ciry ol Ev�rett Uesign and Consiruction <br /> Staneards and Specitications � <br /> 3. Call Location Under��round Service 48 hrs. belore you dig.TOLL FREE NUMBER 1-800•424•5555. � <br /> �%i�;�i� s��� s -- c���s� � l i � <br /> � I <br /> ��. �cf�}/� •-S'/c� ��/� c�.e� lF � <br /> v//�"/�fGnc-'V 5h' c�i�'�ci`-�o c�'f/ //ds'�'Fi�� dId I � ~ <br /> I ~ ~ <br /> � � r: <br /> i <br /> �, i�.�rp o� � � - e�,F'fjiN h'Gc c/f����- � �' � <br /> .� - <br /> a � <br /> � <br /> .� > <br />; � ' <br />' ACKNOWLEDGEMENT O`r CONDITIONS r� �`� <br /> The undersigned owner/applicanl herehy agrees lo hold and save harm� i I,� <br /> less the Ciry of Everetl from any and all claims lor damages, costs, . .r, �� <br /> ' J �f7 <br /> ezpenses, or causes ol aclion that may arise because ot mstallation �_ <br /> / /�� antl maintenance ol ihe �mprovement or other righl-oFway use herelo v <br /> � �� applied for antl turiher agrees to remove same upon notice ��om the <br /> A oved Con ction a�P City an o replace public p pert \maged thereby. " <br /> ` ��ZZ � 7 / I L �: <br /> : <br /> FINAL TI N � 1e Signature o pplicanl v Gato r , <br /> Approv as Gons�ructetl � <br /> WORK AUTNO IS PERMIT MUST BE STARTE WITHIN <br /> evere[t PUBLIC WOR EPARTh7EN 180 DAVS OF DATE PERMIT IS ISSUED AND THEFEAFTEF IS TO <br /> 3200 Cedar Street BE DILIGENTLI' PURSUED TO COMPLETION. THIS PEFMIT hSAY 8E . <br /> Everett,WA 98201 CANGELLED 6Y THE CITV UPON ANY STOPPAGE OF WOAK ON �i IIS <br /> Phone: 259�0815 PROJEC7 O`JER SG G%�'�S DUf;P7iON_ <br />